Cystic lesions of the pancreas: Changes in the presentation and management of 1,424 patients at a single institution over a 15-year time period Journal Article


Authors: Gaujoux, S.; Brennan, M. F.; Gonen, M.; D'Angelica, M. I.; DeMatteo, R.; Fong, Y.; Schattner, M.; Dimaio, C.; Janakos, M.; Jarnagin, W. R.; Allen, P. J.
Article Title: Cystic lesions of the pancreas: Changes in the presentation and management of 1,424 patients at a single institution over a 15-year time period
Abstract: Background: Cystic lesions of the pancreas are being identified more frequently, and a selective approach to resection is now recommended. The aim of this study was to assess the change in presentation and management of pancreatic cystic lesions evaluated at a single institution over 15 years. Study Design: A prospectively maintained registry of patients evaluated between 1995 and 2010 for the ICD-9 diagnosis of pancreatic cyst was reviewed. The 539 patients managed from 1995 to 2005 were compared with the 885 patients managed from 2005 to 2010. Results: A total of 1,424 patients were evaluated, including 1,141 with follow-up >6 months. Initial management (within 6 months of first assessment) was operative in 422 patients (37%) and nonoperative in 719 patients (63%). Operative mortality in patients initially submitted to resection was 0.7% (n = 3). Median radiographic follow-up in patients initially managed nonoperatively was 28 months (range 6 to 175 months). Patients followed radiographically were more likely to have cysts that were asymptomatic (72% versus 49%, p < 0.001), smaller (1.5 versus 3 cm, p < 0.001), without solid component (94% versus 68%, p < 0.001), and without main pancreatic duct dilation (88% versus 61%, p < 0.001). Changes prompting subsequent operative treatment occurred in 47 patients (6.5%), with adenocarcinoma identified in 8 (17%) and pancreatic endocrine neoplasm in 4 (8.5%). Thus, of the 719 patients initially managed nonoperatively, invasive malignancy was identified in 12 (1.7%), with adenocarcinoma seen in 1.1%. Conclusion: Cystic lesions of the pancreas are being identified more frequently, yet are less likely to present with concerning features of malignancy. Carefully selected patients managed nonoperatively had a risk of malignancy that was equivalent to the risk of operative mortality in those patients who initially underwent resection. © 2011 American College of Surgeons.
Keywords: clinical feature; histopathology; patient selection; treatment planning; comparative study; pancreas resection; follow up; prospective study; cystadenoma; intraductal papillary mucinous tumor; pancreas cyst; systematic review; conservative treatment; surgical risk; pancreas adenocarcinoma; surgical mortality; intermethod comparison; pancreas islet cell tumor; surgical patient; pancreas pseudocyst; pancreas duct ligation; pancreatography; stomach partitioning
Journal Title: Journal of the American College of Surgeons
Volume: 212
Issue: 4
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 2011-04-01
Start Page: 590
End Page: 600
Language: English
DOI: 10.1016/j.jamcollsurg.2011.01.016
PROVIDER: scopus
PUBMED: 21463795
PMCID: PMC3817568
DOI/URL:
Notes: --- - "Export Date: 23 June 2011" - "CODEN: JACSE" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Christopher Dimaio
    17 Dimaio
  2. Murray F Brennan
    780 Brennan
  3. Ronald P DeMatteo
    599 DeMatteo
  4. Mithat Gonen
    713 Gonen
  5. Peter Allen
    440 Allen
  6. William R Jarnagin
    590 Jarnagin
  7. Yuman Fong
    745 Fong
  8. Sebastien Gaujoux
    10 Gaujoux
  9. Mark Schattner
    102 Schattner